Provider Demographics
NPI:1144549262
Name:CARROLL, MOLLY A (MD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:A
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:A
Other - Last Name:KIRKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5700 HARPER DR NE STE 410
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3585
Mailing Address - Country:US
Mailing Address - Phone:505-843-7813
Mailing Address - Fax:
Practice Address - Street 1:5700 HARPER DR NE STE 410
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3585
Practice Address - Country:US
Practice Address - Phone:505-843-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0437255207V00000X
NMMD2017-0424207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201098510BMedicaid
NM36037532Medicaid
KS110026003Medicare PIN